 What’s in an autism diagnosis?by Benison O'Reilly on Wednesday, March 3rd, 2010I’ve had one of those days today. Joe is home from school with a virus and fever. Unfortunately I had no choice but to drag him along with us when I took his older brother to the paediatrician’s and then on to big brother’s school: a strict, boys only school that accommodates 1400 young lads, ranging in age from ten to eighteen. I don’t know about your kids but Joe always becomes more autistic when he’s sick and today was no exception. He simply could not control his obsessions and kept inappropriately darting into offices at the paediatrician’s and brother’s school to look at computers. He is interested in Windows® operating systems – don’t ask me why. When we were finally on our way back to the car we passed a couple and their young son, dressed in school uniform, heading the other way. I knew they were on their way to an interview for a year 5 placement at the school in 2011. I knew because my husband and I went through the same process, twice, in earlier years, for Joe’s older brothers. It was a sad reminder how my little boy is different. Joe was on the school’s waiting list like his brothers before him, but when his name came up we politely declined an interview. We could never send him to such a boofy, blokey school. It’s the sort of school where you either sink or swim. Joe would sink. Instead I have his name down at a couple of expensive private schools that boast additional support for kids with special needs. Hopefully he will get a placement in one of these schools for Year 7 (mercifully still some years away). Whenever I get a little down like this I have to remind myself how far he’s come—light years—since diagnosis, six years ago last week. Which brings me to the news, admittedly a couple of weeks old, that the American Psychiatric Association have released their draft Diagnostic and Statistical Manual (DSM)-5, which, as widely predicted, has eliminated Asperger’s syndrome and PDD-NOS as diagnostic categories and instead bundled everyone on the spectrum under the umbrella term, autism spectrum disorder. Their reasons: Because autism is defined by a common set of behaviors, it is best represented as a single diagnostic category that is adapted to the individual’s clinical presentation by inclusion of clinical specifiers (e.g., severity, verbal abilities and others) and associated features (e.g., known genetic disorders, epilepsy, intellectual disability and others.) A single spectrum disorder is a better reflection of the state of knowledge about pathology and clinical presentation; previously, the criteria were equivalent to trying to “cleave meatloaf at the joints”. This decision has provoked controversy. Some parents are aggrieved that their bright, hyper-verbal kids with Asperger’s will been lumped together in the same category as individuals with severe disabilities. I can understand this. Asperger’s sounds a more palatable disorder to most people, especially when so many misconceptions (‘they won’t look you in the eye’, ‘they don’t like people’, ‘they can’t talk’) about autism continue to exist. However, many kids with Asperger’s currently don’t get the support they need at school and maybe a different label will mean their difficulties will be taken more seriously in the future. Also, when I was writing the Australian Autism Handbook I spoke to a leading paediatrician who pointed out that a person with severe Asperger’s (very socially withdrawn, very rigid, very anxious) may well be more disabled than an individual with mild speech and developmental delay, but better social skills and an ability to go with the flow. As others have said, we need to remove the stigma associated with autism and the new DSM may turn out to be an important step. If you’d like to look at the DSM-5 proposed revision for autism spectrum disorder the link is here: http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=94#
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